1801166145 NPI number — KNOWLES, SMITH AND ASSOCIATES, LLP

Table of content: DR. KILLEEN MORENO MD (NPI 1366410672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801166145 NPI number — KNOWLES, SMITH AND ASSOCIATES, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KNOWLES, SMITH AND ASSOCIATES, LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801166145
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2028 LITHO PL STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28304-2538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-485-7070
Provider Business Mailing Address Fax Number:
910-485-1151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2029 VALLEYGATE DR
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28304-3771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-485-8821
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/04/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FIX
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
INSURANCE MANAGER
Authorized Official Telephone Number:
910-485-7070

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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